scholarly journals Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

2021 ◽  
Vol 28 (06) ◽  
pp. 891-895
Author(s):  
Aurangzeb Kalhoro ◽  
Abdul Samad ◽  
Farrukh Javeed ◽  
Sher Hassan ◽  
Lal Rehman
Keyword(s):  
Cerebrospinal Fluid ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
History Of ◽  
Transcranial Approach ◽  
Post Traumatic ◽  
Study Setting ◽  
The Brain ◽  
Small Bone ◽  
Csf Leaks

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material & Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of > 93%

scholarly journals Extracranial Repair of Cerebrospinal Fluid Rhinorrhea

1990 ◽  
Vol 17 (3) ◽  
pp. 320-323 ◽  
Author(s):  
Ian B. Ross ◽  
Austin R.T. Colohan ◽  
Martin J. Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Successful Treatment ◽  
Csf Leak ◽  
High Morbidity ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Transcranial Approach ◽  
Ethmoid Sinuses

ABSTRACT:There has been a recent renewal of interest in the extracranial repair of cerebrospinal fluid rhinorrhea because of the relatively high morbidity associated with the transcranial approach. The authors describe an extracranial approach that involves packing of the sphenoid and ethmoid sinuses on the side of the CSF leak. A case of successful treatment of CSF rhinorrhea by this method is presented. The extracranial approach may be advantageous for the repair of CSF rhinorrhea and the authors advocate an increase in its utilization by neurosurgeons and otolaryngologists working as a team.

scholarly journals Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control

2004 ◽  
Vol 62 (3b) ◽  
pp. 827-831 ◽  
Author(s):  
José Alberto Landeiro ◽  
Marlo S. Flores ◽  
Bruno C.R. Lázaro ◽  
Maria Helena Melo
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Management ◽  
Inferior Turbinate ◽  
Saline Injection ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Control ◽  
Free Grafts ◽  
Cranial Approach ◽  
Csf Leaks

The surgical management of cerebrospinal fluid (CSF) rhinorrhea has changed after the introduction of functional endoscopic sinus surgery.The following three cases illustrate the repair of CSF leaks with the use of rigid endoscope. Two patients had the diagnosis and the site confirmed after intrathecal fluoresceine saline injection. The obliteration of the CSF was achieved with fat free, mucoperichondrial or mucoperiostal free grafts taken from middle or inferior turbinate and kept in place by fibrin glue. Primary closure was achieved in all patients. The repair of the CSF rhinorrhea by endonasal endoscopic surgery is safe, effective and is a valid alternative to the cranial approach.

Evaluation of Endoscopic Transnasal versus Non-endoscopic Routes as Surgical Treatment of Cerebrospinal Fluid Rhinorrhea

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ashraf Mohamed Farrag ◽  
Talaat Ali Hassan El Samnni ◽  
Tamer Abdul Wahab El Sabri Abou El Ezz ◽  
Mohamed Naguib Mohamed El Sayed
Keyword(s):  
Cerebrospinal Fluid ◽  
Meta Analysis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
Fluid Leak ◽  
The Brain ◽  
Better Than

Abstract Introduction Cerebrospinal fluid (CSF) leak happens when there is an abnormal connection between the brain cavity inside and environment outside. It is important to establish a good barrier between the brain tissue and the nose to prevent cerebrospinal fluid leak and protect the brain from exposure to infection. which can be done either by endoscopic or non-endoscopic surgical repair. Patients and methods The aim of this work is to evaluate the effectiveness of endoscopic and non-endoscopic repair of CSF leakage in patients suffering from CSF rhinorrhea. The search retrieved 1693 unique records. We then retained 89 potentially eligible records for full-texts screening. Finally, 11 studies (Total No. of patients = 355) were included in the present systematic review and meta-analysis. Results CSF rhinorrhea resolved in endoscopic surgery group giving a success rate of 88.8%to 100%. recurrence rate is 2% to 12.2% and postoperative complications occurred in 5% to 16.7%. Conclusion The endoscopic approach is highly effective, better than non-endoscopic route and is associated with low morbidity for the management of CSF rhinorrhea .

scholarly journals Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature

2018 ◽  
Vol 44 (3) ◽  
pp. E8 ◽  
Author(s):  
Brandon Lucke-Wold ◽  
Erik C. Brown ◽  
Justin S. Cetas ◽  
Aclan Dogan ◽  
Sachin Gupta ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Skull Base ◽  
Congenital Defects ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Lateral Skull Base ◽  
Csf Diversion ◽  
Csf Leaks

Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions—a rate of 10% of cases is often cited. This can not only lead to morbidity but is also costly and burdensome to the health care system. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair. Given the results of their analysis, they recommend endoscopic endonasal ET obliteration (EEETO) as a first- or second-line technique for the repair of CSF rhinorrhea from a lateral skull base source refractory to spontaneous healing and CSF diversion. They present a case in which EEETO resolved refractory CSF rhinorrhea over a 10-month follow-up after CSF diversions, wound reexploration, revised packing of the ET via a lateral microscopic translabyrinthine approach, and the use of a vascularized flap had failed. They further summarize the literature regarding studies that describe various iterations of EEETO. By its minimally invasive nature, EEETO imposes less morbidity as well as less risk to the patient. It can be readily implemented into algorithms once CSF diversion (for example, lumbar drain) has failed, prior to considering open surgery for repair. Additional studies are warranted to further demonstrate the outcome and cost-saving benefits of EEETO as the data until now have been largely empirical yet very hopeful. The summaries and technical notes described in this paper may serve as a resource for those skull base teams faced with similar challenging and otherwise refractory CSF leaks from a lateral skull base source.

scholarly journals SPONTANEOUS CEREBROSPINAL FLUID LEAK AFTER INITIATION OF DOPAMINE AGONIST THERAPY IN MACROPROLACTINOMAS: TWO CASE REPORTS AND A LITERATURE REVIEW

2020 ◽  
Vol 6 (2) ◽  
pp. e90-e93
Author(s):  
Jonea Lim ◽  
Mitali Talsania ◽  
Madona Azar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Dopamine Agonist ◽  
Csf Leak ◽  
Resonance Imaging ◽  
Csf Rhinorrhea ◽  
History Of ◽  
Beta 2 ◽  
Csf Leaks

Objective: To describe 2 spontaneous cerebrospinal fluid (CSF) leaks complicating treatment of macroprolactinoma (MPRL) with dopamine agonist (DA) therapy. Methods: We present the 2 cases of spontaneous, DA-related CSF leaks. Prolactin levels were used to assess hyperprolactinemia. Beta-2 transferrin was tested in rhinorrhea fluid, and magnetic resonance imaging was used to assess the sella. Results: Case 1 was a 45-year-old woman with a history of MPRL, recently started on bromocriptine at 15 mg/day, presented with clear rhinorrhea, headache, and nuchal rigidity. Magnetic resonance imaging showed a large sellar lesion extending into the cavernous sinuses, posterior sphenoid sinuses, and suprasellar cistern. Computed tomography revealed areas concerning for bony erosion, likely representing leak sites, and the rhinorrhea fluid was positive for beta-2 transferrin, confirming the CSF source. Empiric antibiotics for meningitis were given and she underwent urgent neuroendoscopic, transsphenoidal CSF leak repair and debulking of the pituitary mass. Case 2 was a 55-year-old man with a 10-year history of untreated MPRL who was started on bromocriptine at 5 mg/day 2 weeks prior to admission. He presented with clear rhinorrhea and a metallic taste in his mouth, worse with the Valsalva maneuver. Imaging confirmed clinical suspicion and he was taken for surgery. A high-flow CSF leak was encountered once the tumor was debulked. This was repaired with an abdominal fat pad graft. Both patients developed diabetes insipidus and required postoperative adjuvant DA therapy. Conclusion: Spontaneous CSF leaks can complicate medical therapy of large MPRL with underlying skull defects, typically within weeks of initiation of DA. This should prompt clinicians to educate patients about the symptoms of potential CSF rhinorrhea and encourage them to promptly report them.

scholarly journals Study of Management of Cerebrospinal Fluid Rhinorrhea

2021 ◽  
Author(s):  
Himanshu Raval
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Picture ◽  
Causative Factor ◽  
Treatment Modalities ◽  
Common Site ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Runny Nose ◽  
The Brain ◽  
Nose And Sinuses

AbstractCerebrospinal fluid (CSF) rhinorrhea is a condition where the protective fluid that surrounds the brain finds its way into the nose and sinuses, often appearing as a very watery runny nose. In this study, we are looking for clinical picture, various available investigation and treatment modalities, and their outcomes. In this study, we include 60 patients diagnosed with CSF rhinorrhea irrespective of cause. Patient having similar clinical picture but ruled out by investigation are not included. We obtain result in terms of most common causative factor, common site, and efficacy of treatment, and can decide a favorable line of management with respect to different circumstances.

scholarly journals Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases

2014 ◽  
Vol 7 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Mohnish Grover ◽  
Pawan Singhal ◽  
Shashank Nath Singh ◽  
Man Prakash Sharma ◽  
Avani Jain
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
The Past ◽  
Intracranial Complications ◽  
Csf Leaks

ABSTRACT Cerebrospinal fluid rhinorrhea results from a breakdown of barriers between the subarachnoid space and aerodigestive tract. Because of the risk of potential intracranial complications, all persistent cerebrospinal fluid (CSF) leaks should be repaired. Over the past few decades, with the advances in endoscopic techniques, the surgical management of CSF rhinorrhea has changed significantly. CSF leak repair has advanced from the conventional open intracranial approaches by neurosurgeons to the transnasal endoscopic ones by otorhinolaryngologists. In this study, 35 patients with CSF leaks underwent endoscopic repair with a 94.3% first attempt success rate, and 100% overall success rate. There were no major intraoperative or postoperative complications. To conclude, the endoscopic approach has a high success rate with minimal morbidity and has therefore, become the preferred method. How to cite this article Jain A, Singhal P, Sharma MP, Singh SN, Grover M. Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases. Clin Rhinol An Int J 2014;7(2):47-51.

scholarly journals A 17-years-old girl presenting with spontaneous cerebrospinal fluid rhinorrhea diagnosed as aqueductal stenosis: A case report

2016 ◽  
Vol 7 (2) ◽  
pp. 134
Author(s):  
Umma Salma ◽  
Mohammad Abdus Sattar Sarker ◽  
Abed Hossain Khan ◽  
Nahida Zafrin ◽  
M. A. Jalil Chowdhury
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Case Report ◽  
Ventriculoperitoneal Shunt ◽  
Chronic Headache ◽  
Aqueductal Stenosis ◽  
Empty Sella ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
History Of

<p>A 17-year-old girl presented with chronic headache and spontaneous CSF rhinorrhea. She had no history of head trauma. MRI of her brain showed aqueductal stenosis associated with triventriculomegaly with partially empty sella. Following insertion of ventriculoperitoneal shunt, her headache and CSF rhinorrhea completely recovered. Though very uncommon but aqueductal stenosis should be kept as a differential diagnosis for etiology of chronic CSF rhinorrhea.</p>

scholarly journals Management and outcome of post-traumatic cerebrospinal fluid rhinorrhea

2020 ◽  
Vol 8 (3) ◽  
pp. 937
Author(s):  
Nasiru Jinjiri Ismail ◽  
Ali Lasseini ◽  
Aliyu Muhammad Koko ◽  
Bello Bala Shehu
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Sub Saharan Africa ◽  
Aetiological Factor ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Post Traumatic ◽  
Sub Saharan

Background: Post-traumatic cerebrospinal fluid (CSF) rhinorrhea are relatively uncommon neurosurgical condition that is associated with serious morbidity and life-threatening complications like meningitis. As such, it requires prompt and thorough evaluation and treatment. Is of note that, only few studies discussed CSF rhinorrhea in literature especially in sub-Saharan Africa. This study was designed to report outcomes of management of post-traumatic CSF rhinorrhea seen in our institution.Methods: Relevant data of all patients with post-traumatic CSF rhinorrhea managed from July 2015 to June 2019 were retrospectively reviewed.Results: Out of the total 1942 cases of head injury managed over the study period 20 cases (1%) were diagnosed with CSF rhinorrhea. The mean age of presentation was 30.5 years. All patients were male and road traffic accidents was the only aetiological factor noted. Majority of patients developed rhinorrhea after 48 hours of injury (12/20). Pneumocephalus was the commonest computerised tomographic scan finding and about 2/3rd of the patients required operative treatment by transcranial anterior cranial fossa repair (13/20). The remaining patients were managed non-operatively with acetazolamide, antihistamines, stool softeners and antibiotics. The outcome was generally good with no recurrence noted. The rate of mortality was 10% (2/20) and resulted from meningitis.Conclusions: Posttraumatic CSF rhinorrhea was seen in 1% of cases of head injury in our environment and affects males predominantly. Although, the outcome of treatments was good, 10% mortality caused by meningitis was recorded.

Spontaneous cerebrospinal fluid rhinorrhea associated with dysplastic optic discs and a basal encephalocele

1981 ◽  
Vol 54 (6) ◽  
pp. 807-810 ◽  
Author(s):  
Dennis E. Bullard ◽  
H. Alan Crockard ◽  
W. Ian McDonald
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Basal Encephalocele ◽  
History Of ◽  
Nasal Secretions ◽  
Funduscopic Examination ◽  
Optic Discs

✓ A 24-year-old man presented with a history of recurrent meningitis secondary to cerebrospinal fluid (CSF) rhinorrhea. The patient had bilateral optic disc dysplasia in association with a basal encephalocele, but had no midline facial anomalies. The syndrome is rare, and this is the first report of a patient with this disorder in the absence of facial or radiographic anomalies. The case serves to emphasize the importance of funduscopic examination in patients with spontaneous CSF rhinorrhea or recurrent meningitis, and stresses the value of Dextrostix examination of nasal secretions in the evaluation of suspected CSF rhinorrhea.

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